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INAUGURAL  DISSE^rATltJN 

ON    THE       '        '  V\  5%    /,;   ?■>">    V 

DIARRHOEA  INFANTUM. 


SUBMITTED  to  the  PUBLIC  EXAMINATION 

OF  THE 

FACULTY   OF   PHYSIC, 

UNDER   THE   AUTHORITY  OF   THE 

TRUSTEES  OF  COLUMBIA  COLLEGE, 

IN    THE 

STATE  OF  NEW-YORK: 
WILLIAM  SAMUEL  JOHNSON,  L.  L.  D.  Prefident 

FOR  THE   DEGREE   OF 

DOCTOR   of  P  HTS  IC; 

ON  THE    FIFTH    DAY   OF    MAY,     1 79j- 


By    P%E  TER  ANDF.RSO  N,  A.  B. 

And  Citizen  ot  the  State  ot   New-York. 


Non  f  c,   non   purnuram,  non  n  altum  divitias, 

n"n  in  naturn  ( i  hnbutum  ; 

fed  .-..;  -r.uju  utilitati  info  vienfem,  dignitas   fequitur. 

Nichols. 


NEW-    . 
TIEBOU1 

—1795.— 


Imprimatur 

w.  P.  SMITH. 


d(£Z, 
(71S- 


WILLIAM  SAMUEL  jbtul^N; l'tii  & 
PRESIDENT  of  COLUMBIA  COLLEGE  5 

Whofe  Eloquence,  Wifdom  and  Talents , 

as  an 

Orator  and  Statesman  ; 

Whofe  elegant  Erudition,  as  a  Scholar ; 

And  whofe  Virtue  and  Philanthrophy,  as  a 

Member  of  Society, 
Will  ever  render  his  name  juftly  refpefted,. 


1 

ALSO,    TO 


NICHOLAS  ROMAYNE,  M.  D. 

<yjlu  t/iol&  aim  j'adhhU  O  idor  ; 

A  perfon  eminently  diflinguifhed  for  his 
deep,  and  extenfive  acquaintace  with  the  whole 
circle  of  Medical  Science,  for  his  humanity  and 
ufefulnefs,  in  the  practice  of  his  profeffion  ; 

And  for  his  poiitenefs,  as  a  Gentleman  : 

THIS 

DISSERTATION 

Is  Infcribcd, 

With  the  mod  fincere  fentiments  of  gratitude 
and  refpecl, 

By  their  obliged  Friend, 

And  fellow-citizen, 

The  AUTHOR. 


ERRATA., 

ige    a,   Line  &,   for  two,  read  too. 

do*  7,   for  prevaling,  prevailing. 

do.  7  of  the  Note,  for  ferret,  fecrete. 

2d,  line,  from  thebotlorn,  for  '  diieafe,5    'dileafes.' 

15,  20,  for  emotion,  emotions. 

j  6,  22,   for  two  too.. 

%%,  i,  after  the  word  "this,."  imert  "general, 


DISSERTATION 

ON   THE 

DIARRHOEA  INFANTUM. 


N. 


O  difeafes,  to  which  man  is  fubjecr.  in  the  different 
progreihVe  ftages  of  his  life,  more  neceffarily  claim  our 
compaHIon,  and  the  extenfion  of  medical  aid,  than  thofe 
which  are  incident  to  the  periods  of  infancy  and  child- 
hood. The  greyt  fenfibility  and  irritability  of  infants,  the 
accfcent  nature  of  their  food,  their  incapacity  for  exercifc, 
and,  above  all,  the  mifmanagement  of  thofe,  who  have  the 
immediate  care  of  them,  render  them  peculiarly  the  fubje&s 
of  pain  and  difcafe.  So  great,  indeed,  is  the  mortality 
among  children,  in  large  cities,  that,  by  pretty  accurate 
ellimates,  it  has  been  found,  that  above  one  half  of  them 
die,  within  the  fir  (I  four  and  five  years.* 

Until  the  age  of  five,  "  human  life,  like  a  fire  beginning 
to  bnrn,  is  very  feeble,"  and  eafily  cxtinguifhed. — various 
are  the  caufes  and  feats  of  thefe  difeafes.  But  fome  of  the 
niofl  frequent,  and  fuch  as  are  attended  with  the  mod  dif- 
tr  effing  fymtoms,  are  thofe,  which  affect  the  alimentary 
canal.  Of  fuch  genera]  importance  to  the  human  (economy, 
he  due  action  of  thefe  parts  been  deemedj  that  Hip* 
Id  fome  others  of  the  ancient  Phyficians.confidered 

amorh  I   date  of  them,   as  the    principal  and 

'  .— Sinii'u  Letteri — 


6falh?xf  fotirce  cf  iitfarfule  -difeafes.  Certain  we  are,  that 
this  clafs  oi  uifeafes,  bbth  from  the  frequency  of  their  occur- 
rence, ^hd/thegrea-t  mortality  attending  them,  demands  the 
niceit  attention.  I  fhali,  however,  confine  myfelf  to  the 
confideration  of  one  particular  genus  of  them,  the  Diarrhoea, 
or  purging  of  Children.  This  difeafe,  particularly  in  its 
mod  malignant  forms  has  been  viewed  as  a  fpecies  of  Cholera 
morlns,  and  hence  denominated  the  "  Cholera  Infantum." 
But,  that  this  is  not,  in  general,  a  different  difeafe  from  the 
Diarrhoea,  bur.  merely  a  variety  or  modification  of  the  fame 
fpecies,  will  I.  conceive,  fully  appear  from  the  following 
confiderations. 

i.  Becaufe  it  attacks  children  of  the  fame  age,  and  habit 
of  body,  as  the  Diarrhoea. 

2.  That,  in  a  great  proportion  of  cafes/  even  in  the  fum- 
imr  months,  a  fimple  Diarrhoea  alone  appears,  unaccompa- 
nied with  any  vomiting. 

3.  That,  even  in  thofe  inflances,  where  a  vomiting  does 
truly  take  place,  it  is  often  merely  of  the  aliment  taken  in, 
of  a  four,  greenifh,  or  other  matter  different  from  bile.* 

4.  Bile  feldom  appears  in  the  firfl  afts  of  vomiting,  and 
feems  afterwards  to  be  poured  too  copioufly  into  the  flomach 
and  duodenum,  from  the  previous  agitation  of  the  abdomi- 
nal vifcera,  and  the  debility  and  relaxation  induced.  The 
more  rrequent  appearance  of  vomiting  in  the  Diarrhoea  of 
Infants,  than  in  that  of  Adults,  arifes  from  the  greater 
irritability  of  the  former,  than  of  the  latter. 

5.  It  is  deftitute  of  fome  of   the  other   fymptoms  of  a 
genuine  Cholera. 

6.  It  is  probable,  both  from  the  nature  of  children's  food, 

and  the  general  difpofition  of  their  fyftems  to  a  fuperabun- 

dance 

*  Gerardi  Van  Swietan  Comment,  in  Boerh    Tom.  4.— -Halleri  opera 
majora  Tom,  6.  P.   548, 


(     9-    ) 

dance  of  acid,  as   well  as  from  the  evident  marks  of  acidity 
in  the  primce  vis,  that  a  true  Cholera  docs  feldom  occur. 

7.  This  probability  is  further  fupported  by  thewtll  known 
mild  and  inert  nature  of  the  bile  in  infants.* — "  In  infants 
the  bile  is  frequently  not  fufficiently  active,  and  generally 
fecreted  in  two  fmall  a  quantity,  which  in  them  induces  dif- 
eafes  of  prevaling  acidity. "f 

8.  And,  laftly,  we  may  conclude  both  complaints  to  be 
generally  of  the  fame  nature,  as  well  from  their  origin, 
which  is  moftly  in  the  form  of  a  Diarrhoea  ;  as  alfo  the  me- 
thod of  cure  and  prevention,  which  reft  principally  upon 
the  view  of  obviating  and  correcting  acidity.  The  treat- 
ment being  likewife  different  from  what  is  proper  in  the 
Cholera  of  adults  ;  and  in  infants,  nearly  the  fame,  whether 
accompanied  with  vomiting  or  not,  and  in  cafes  of  vomiting, 
whether  with  bile,  or  any  other  matter. 

From  all  thefe  confiderations,  it  will  he  pretty  evident, 
that  a  vomiting,  ando  ther  violent  fymptoms,  and  even  a  vomit- 
ing of  gall  are  not  always  fufficient  to  conftitute  a  different 
genus  of  difeafe,  but  only  perhaps  a  diftindl  fpecies  or  variety, 
included  under  the  Genus  Diarrhoea.  £  HIS- 

*  Halleri  Phyfiolagia. 
+  Dr.  Saunders  on  the  liver. 

*    The    fize   of  the    liver   in    the    foetus,  and   foon  after  birth,  is  no 
proof  of  a  contrary  doctrine  ;  as   it  is  particularly  large  in   the  former 
flatc,   without    any    known  adequate    ul'c    for    the   bile.      And  as  other 
Glandular  parts  :irr-  alio  larger  at   the fe  two    periods,  than  at  any  oehcr 
period,  without  our  being   able  to   afecrtain   their  ufes.     '■  We  do  not 
know  the  whole  function  of  the   liver  :    we  know  that  its  principal  ufe 
fe<  ret  the  bUe,  but  then  in   the  fceius  it  ojbupies  the 
.1  the  cavity  ol  the  abdomen,  and   a  confiderable  portion 
ol  th<-  blood,  returning  from  the  placenta,  circulates  through  its  Pub- 
ftance.     I    occupiei  lets  fpace  in  proporrion   in  the  cavity  ol  the  abdo- 
men, as   the   body  grows  up,  and    it  is  more  than   probable,    thai    il 
11  function  nol  yel  underflood  "     Whai  greatly  favoui 

fize  ol    the  blood-vi  II  ited  to  the 

:i  are  double 
mm  '   '"  ""v  other 

gee  Ci  he  Abforbenl  Syfl  :id 


(  1°  ) 

HISTORY  of  the  DISEASE. 


Definition.' Dejeftio  frequens  ;  morbus  non  contagiofus  ;  pyrexi 

nulla  primaria. 

Culhni.     Kofofogia  Method 


THIS  difeafe  may  arife  at  any  period  of  the  infant 
ftate  £  and  few  children  entirely  efcape  it.  It  alfo  affumes 
various  appearances.  But,  it  is  my  intention  to  defcribe  it 
only,  as  it  occurs  as  an  idiopathic  difeafe  ;  and,  more  parti- 
cularly, that  form  of  it,  which  prevails  during  the  warmer 
feafons  of  the  year. 

Although  this  complaint  may  attack  children  of  any  age; 
we  find  that  it  moll  frequently  occurs  from  the  fecond  or 
third  week  after  birth,  until  the  third  and  fourth  year. 
It  becomes  moil  prevalent,  and  is  attended  with  fymptoms 
of  the  greaietl  danger  and  malignity,  during  the  warmer 
months  of  fummer,  and  the  beginning  of  autumn  ;  when  it 
is  known  by  the  common  name  of  "  The  Difeafe  of  the 
Seafon."  It  always  fpreads,  and  affumes  a  more  dangerous 
form,  in  proportion  as  the  heat  of  the  feafon  increafes. 
Alfo,  as  the  weather  is  fubjefl  to  fudden  and  confiderable 
viciffitudes  of  heat  and  cold.  Sudden  and  long  continued 
falls  of  rain,  after  a  very  warm  and  dry  ftate  of  the  at- 
mofphere,  greatly  favour  the  operation  of  the  exciting 
caufes.  For  thefe  reafons,  we  find,  that  during  the  courfe 
of  the  fummer  of  1793,  it  prevailed,  in  this  city,  to  aa 
alarming  and  dangerous  degree  ;  whereas,  from  the  mildnefs 
and  almoft  uniform  temperature  of  the  atmofphere,  during 
the  laft  fummer,  it  was  comparatively  of  rare  occurence., 
It  generally  begins  in  the  month  of  June  or  July,  and  con- 
tisaues  till  ths  latter  part  of  September.     Although,  frona 


(  "  ) 

the  premature  heats  of  fummer,  it  may  appear  much  earlier  j 
or,  from  the  unufual  continuance  of  the  fame,  be  coniider- 
ably  protracted. 

The  firft  appearance  of  this  difeafe  is  marked  commonly 
by  a  moderate  degree  of  lootenefs ;  though  fometimes,  a 
conitipation  precedes  the  Diarrhoea.  This  loofenefs  is  diflin- 
guifhed,  according  to  the  appearance  of  the  matter  difcharged, 
The  mod  common  appearance  of  it  is  green,  and  curdled, 
emitting  a  four,  and  peculiarly  rank  odour  ;  but,  the  ftools 
are  alfo  clayey,  watery,  bloody  and  fetid.  In  fome  cafes, 
particularly  in  the  advanced  ftages  of  the  complaint,  they 
confift  (as  in  the  Lientery  of  Adults)  merely  of  the  aliment 
taken  in,  without  having  undergone  any  material  change  in 
its  paffage.  Acid  and  bitter  eradiations  generally  attend. 
Vomiting,  alfo,  frequently  occurs  throughout  the  courfc  of 
the  complaint,  particulaly  during  the  exceffive  heats  of  kSum- 
mer.  The  matter  thrown  up  is  green,  or  yellow.  Some- 
times the  vomiting  continues  without  the  purging  ;  though 
more  frequently  the  contrary.  The  abdomen  is  often  affed •■ 
ed  with  a  confiderable  hardnefs  and  fwelling.  Thefe  fymp- 
toms  are  accompanied  with  fevere  pain  and  griping  ;  which 
we  may  know  from  the  child's  ftarting,  and  frequent  fits  of 
crying,  when  attempting  to  fleep,  and  the  forcible  contrac- 
tion of  its  arms  and  legs  towards  the  abdomen.  A  great 
degree  of  thirft  moftly  attends.  The  pulfe  is  weak,  quick, 
and  frequent.  The  fkin  hot  and  dry,  efpecially  about  the 
head  ;  but,  as  the  difeafe  advances,  the  extremities  become 
cold  ;  fometimes  remarkably  fo,  while  the  belly  is  as  re- 
markably hot.  In  long-continued  Diarrhoeas,  a  procidentia 
a;ii  fometimes  takes  place,  which  proves  a  very  obftinate 
and  troublcfome  fymptora.     The  duration  of  the  difeafe  is 

B    2 


t    12    ) 

various.  In  fome  inftances,  it  terminates  in  a  few  days; 
but,  in  others,  it  continues  with  little  or  no  remiffion,  for 
a  month  or  more.  I  have  known  it  to  continue,  in  fome 
children,  for  three,  four,  and  five  months,  with  very  few 
occafional  alterations.  Eruptions  on  the  flan,  will  fometimes 
appear  during  its  progrefs.  And,  in  complaints  of  long 
{landing,  a  peculiar  tightnefs  of  the  fkin  (called  Jhin-bound) 
is  faid  by  medical  writers,  to  take  place.*  In  the  word 
ftage  of  it,  there  is  a  conftant  inclination  for  ftool,  though 
the  {tools  are  little  in  quantity,  watery  and  green. — - 
At  kit  the  eyes  become  hollow  and  languid,  with  fome- 
thing  of  a  pearly  whitenefs  in  them,  the  body  is  fo  greatly 
emaciated,  that  the  bones  almofl  protrude  through  the  fkin, 
a  fore  mouth,  livid  fpots,  hiccup,  convulfions,  and  a  ftrongly 
marked  hippocratic  countenance  generally  precede  the  fatal 
termination. f 


y  a  &bj 


DIAGNOSIS. 


THE  difeafes,  with  which  a  Diarrhoea  in  children,  may 
be  confounded,  are  a  genuine  Cholera  morbus,  a  Dyfentery 
and  worms  in  the  alimentary  canal. 

1.  To  diflinguifn  it  from  Cholera,  we  may  be  affifled, 
in  fome  degree,-  by  attending  to  the  feafon,  in  which  it  hap- 
pens ;  by  the  matter  vomited,  as  we'll  as  that  difcharged  by 
ftool,  being  entirely  of  a  bilious  nature,  in  the  latter ;  from 
this  complaint  being  of  fhort  duration,  and  attended  with 
violent  fymptoms  from  its  commencement. 

2.  From  the  Dyfensery,  by  its  not  being  contagious  ;  by 
its  not  being  attended  with  that  pungent  pain,  griping,  and 

*   Dr.  Underwood. 

+  Dr.  Rufh's  Med.  Inquiries,  vol.  i, 


(     '3     ) 

tenefmus,  which  are  fo  dittreffiug  in  Dyfintery.  We  may 
alfo  form  our  judgment,  from  the  fever  not  being  of  that 
highly  typhous,  malignant  nature,  that  it  is  in  the  latter 
complaint,  and,  upon  the  whole,  from  the  Dyjlntery  being 
a  very  rare  difeafe  among  children. 

The  3d.  difeafe,  with  which  it  may  be  confounded,  is 
the  affection,  ariiing  from  ivorms  in  the  alimentary  canal. 
But  from  this,  it  will  be  fufficiently  diuinguifhed,  from  there 
not  having  been  any  woims  difcharged  in  the  firft  attack  of 
the  difeafe  ;  from  an  attention  to  the  epidemic  conilitution 
or  nature  of  difeafe  moft  prevalent ;  and  from  its  not  having 
been  preceded  by  a  voracious  appetite,  difturbed  Seep,  Sue, 
The  appearance  of  the  ftools  will  be  different  ;  and  the 
effential  charac~T.eiift.ic  fymptoms  of  worms    will  be  wanting. 


CAUSES. 

THESE,  as  ufual,  (hall  be  divided  into  the  Remote  and 
Proximate  ;  and  the  firft  fubdivided  into  the  Predifponent 
and  exciting  caufes.  We  (hall  conllder  them,  as  they  fuc- 
ceed  each  other,  in  the  order  of  time,  and  approximate  the 
perfect  ftate  of  difeafe. 


PRE  DISPONENT    CAUSES. 

"  Predi8POS1TIOK,  being  that  Mate  of  the  body,  which 
n  .  a  pcrfon  fufeeptible  of  the  operation  of  the  Exciting 
or  Occaf,';nal  c.ufeb  ;"  the  following  may  be  viewed  as  the 
principal   prtdifpotunt  caufts  yf  the    complaint,    under    con- 

1.  An 


(      '4     ) 

1.  An  hereditary  difpofition,  arifing  from  weak  and  de- 
praved parents,  producing  a  weak,  fickly  organization. 

2.  A  peculiar  irritable  ftate  of  the  fyftem,  or  of  the  fto- 
mach  and  bowels,  arifing  either  from  natural  conformation, 
independant  of  hereditary  taint,  or  a  difeafed  ftate  of  the 
body  ;  as  happens  frequently  from  dentition,  &c. 

3.  A  particular  ftate  of  the  atmofphere,  either  a  very 
warm,  and  moift,  or  cold  and  variable  ftate  of  it. 

4.  A  diet  affording  little  nutritious  matter,  or,  atleaft, 
affording  matter,  which  requires  to  undergo  certain  changes 
from  fermentation,  in  the  ftomach,  before  it  can  be  con- 
certed into  chyle.  Hence  a  vegetable  diet,  either  in  whole 
or  chiefly  fo,  and  of  a  bad  quality,  often  lays  the  foundation 
for  this  diforder. 

5.  Breathing  an  impure  and  confined  air.* 

6.  The  want  of  that  due  exercife,  the  defire  of  which  i» 
mftinftively  implanted  in  the  breaft  of  every  child. 

7.  An  inattention  to  cleanlinefs. 

8.  and  laftly.  The  neglect  of  purging  off  the  meconium^ 
foon  after  birth,  frequently  lays  the  foundation  for  this  com- 
plaint, by  irritating  and  ovtfrftretching  the  inteftines.f 


EXCITING     CAUSES. 

ONE    of  the  moft   frequent   exciting  caufes  of   difeafes 
of  the  alimentary  canal  in  children,  is  generally  ailowed  to  be 
a  fnperabnndant  acidity.:}:     This  appears  to  be  fuch  a  com- 
mon 

*  Dr.  Bryan  Robinfon  has  fhewn,  that  infants  contain  moreblood,  in 
proportion,  than  adults.  And  it  is  well  known,  that  their  circulation 
is  much  quicker,  and  of  courfe  their  refpiration.  Hence  there  is  a 
greater  quantity  of  impure  air  emitted  from  theij  lungs.  See  Me- 
moirs of  the  Arts  and  Science,     Vol,   2d. 

t  Dr.  Underwood's  "  Treatife  on  the  difeafe  of  children." 
t  Harris  "  de  morbis  Infantum."     Cullen's  "  firfl  Lines." 


(     '5     ) 

mon  caufe,  that  Harris,  who  isefteemed  a  very  good  writer 
on  the  difeafes  of  children,  has  attributed  every  morbid  af- 
fection, to  which  the  infant  Hate  is  liable,  to  this  fource. 
And,  in  fact,  from  the  food  of  infants  being  of  a  very 
acefcent  nature,  and  readily  undergoing  fermentation  in  the 
ftomach,  as  well  as  from  various  phenomena,  that  take  place, 
we  can  have  little  doubt  of  acidity  being  a  very  common  caufe 
of  this  difeafe-* 

But,  perhaps,  acidity  is  more  frequently  a  coufgquence  of 
debility  and  difeafe  ;  than  the  caufe  of  them. 

The  2d.  caufe  is  irregularity  in  diet.     The  tender  bowels 

of  children  may  either  be  oppreffed  by   too  great  a  quantity 

of  food,   or  irritated   by  that,  which  is  difficult  of  digeftion, 

and  liable  to  become  acrimonious  from  its  delay  in    the  fn'fl. 

pafTages. 

A  3d.  caufe  may  be   fuppofed  to  be  paffions  of  the  mind, 

either  in  the  nurfe,  or  child.     That  the  firft  may    operate  by 

altering  the   quality  and  quantity    of  milk  fecreted,  is   very 

probable  from  the  very   intimate    connection,     and   mutual 

influence,     which   fubfift  between     various    emotion   of   the 

mind  and  glandular  fecretions.     And,    that  paffions  of  the 

mind 

*  I  would  not  have  it  underftood,  from  what  is  here  faid,  that  I  fup- 

pofe  the  milk  of  the  mother  to  be  the  general  caufe  of  this  morbid 

acidity.     Milk,  both  from  its  general  properties,  and  its  being  almoil 

the  univerfal   food,   provided   by  nature,  for   the  nourifhment  of  the 

orn  animal,  is  evidently  the  heft  adapted  for  the  weak  digeftive 

organs  of  Infants.     But,  when  the  flomach  of  an  Infant  is  debilitated, 

11  the  jnilk.  ol  the  nurle  becomes  vitiated  by  grief  or  other  emo- 

->:  the  mind,  difeafe,  or  improper  food,  it  may  undergo  fimilar 

chang'  bles,  from  fermentation.     Thefe  law  very  readily  pafs 

;h  the  acid  fermentation,  when  expofed  to  a  moderate  hcai,  out 

body.     Hence  probably,  in  certain  ftatca  ol  the  fyftem,  fi 

changes  take  place,  during  the  proccl  ch  and 

•  ■  n  ,i\  his  opinion,  thai  "I  al  I 

the  children,  in  tl  hat  arc  dry  ''1  who 

die  under  four  mc  lirdi   01   even  ihri     fourths  fall  victims 

h   .ind  boweii    occafioned  by  improp  ■ 

Pj   igl  r  and  Di    M'Bride  oo  Fermentation. — Mois 

•  :.   >'.  .        I 


(     16     ) 

mind  in  infants,  will  produce  Diarrhoea,  maybe  concluded 
from  the  powerful  effe£l  they  have  on  the  brain  and  Nervous 
Syltem,  which  in  infancy  are  peculiarly  large  and  fenfible. 
In  confirmation  of  it,  we  may  alfo  adduce  the  inftances  of 
adults,  who  are  liable  to  the  fame  complaint,  from  a  fimilar 
caufe.* 

4.  The  fudden  repulfion  of  certaineruptions  on  the  fkin. 
This  fometimcs  happens  with  the  Exanthemata,  the  red 
Gum,  &c. 

5.  The  fudden  ftoppage  of  perfpiration,  from  a  moid  and 
cold  ft'ate  of  the  atmofphere.  An  obftruftion  of  perfpiration 
may  alfo  arife  from  want  of  cleanlinefs,  which  may  further 
operate  by  favouring  the  generation,  if  not  actually  generating 
an  acrimony  of  the  fluids.  Cold  particularly  produces  this 
difeafe,  when  applied  to  the  feet,f  and  probably,  from  fome 
part  of  the  clothing  of  Infants,  applied  over  the  abdomen, 
being  fuffered  to  remain  on  damp  and  cold. 

6.  A  very  warm,  and  dry  ftate  of  the  atmofphere,  parti- 
cularly if  long  continued. 

The  7'ch.  and  la  ft  caufe  of  this  complaint,  is  the  ufe  of 
the  draftic  purgatives,  or  the  long  and  two  frequent  ufe 
of  rhubarb,  magnefia  alba,  &c.  which  by  irritating  the 
interlines  may  produce  aDianhoea.J 


PROXIMATE     CAUSES. 

%  . 

In   eftabliihing   the  proximate    caufe   of  Diarrhoea,  there 
has  been   a  great  diveffity  of   fentiment  among  phyficians. 

Some 

*  Gaubii   Pathologia-— Cul'en's  Firfl:  Lines. 
+  Throwing  cold    water  on   the  lower  extremities,  has   lately  been 
found  a  very  effectual  remedy   in  removing. obftinate  coftivenefs.  Med. 
*~  '"  -1  t   Hamilton. 


(     '7    0 

Some  fuppofe  it  to  confift  in  a  fpafmodic  affection,  arifing 
from  an  atony  and  debility  of  the  parts.*  Others  affirm, 
that  it  arifes  from  a  laxity  of  the  mufcular  fibres.  Dr.  Brown 
claffes  it  among  the  afthenic  difeafes,  and  alledges,  that  it 
arifes  from  direct  debility. f  But,  the  mod  probable  opi- 
nion feerns  to  be  that,  which  imputes  it  to  an  increafed 
periftaltic  motion,  of  the  inteftinal  canal,  arifing  from  the 
action  of  ftimulants.^: 

What  is  the  peculiar  nature  of  the  ftimulants,  that  more 
immediately  excite  the  action  of  this  canal,  is  difficult  to 
determine.  Although,  from  many  circumftances  of  their 
operation,  as  well  as  from  direct  poilons  often  operating  in 
the  fame  way  ;  I  am  inclined  to  believe,  that  it  is  owing  to 
fome  noxious  quality  in  the  fubftances,  which  in  a  certain 
quantity  might  prove  deftructive  to  the  fyftem.$ 

That  acidity  operates  as  a  ilimulus  to  the  inteftinal  canal, 
may  be  inferred  from  the  vegetable  acids  (of  which  nature 
is  the  acid  in  the  ttomach)  readily  exciting  appetite,  and 
increafing  fome  of  the  fecretions  ;  as  alfo  the  general  bene- 
ficial effects  of  the  fermented  vegetable  acid,  as  an  externa: 
application,  in  obviating  and  corretling  putrefcency.  Hence 
its  frequent  life  in  contagious  fevers  of  great  debility. 

But,  it  is  not  improbable,  that  a  redundant  acidity  is 
very  much  favoured  in  its  operation,  by  exciting  the  mu- 
cous follicles  of  the  inteflines  to  a  larger  exudation  of  their 
contents,  and  rendering  more  acrid  the  mucus  thus  poured 
out.  It  may,  alfo,  have  an  effect  of  eroding  the  mouths 
of  thefe  veffelis,  as  well  as  the  inner  coats  of  the  inteftines,j{  < 
and  thus  increafing  their  irritability.  When 

...  ;   i  ta  Medicine. 

Med, 
mony  i>  known  fo  ■  !  '" 


■  C    is    ) 

When  a  Diarrhoea  arifes  from  a  fuppreifion  of  the  per- 
fpirable  matter,  or  the  fudden  repulfion  of  eruptions  from 
the'  fkin,  k  is  to  be  imputed  to  the  fympathy,  that  fubfifts 
between  the  furface  of  the  body  and  the  alimentary  canal. 

It  remains  flill  a  queftion  to  be  decided,  how  far,  and  in 
what  manner,  heat  is  to  be  confidered  as  the  caufe  of  this 
difeafe.  As  this  is  a  fubject,  which  has  not,  to  my  know- 
ledge, been  fully  examined  by  any  medical  writer,  it  would 
be  great  prefumption  in  me  to  pretend  to  efrahlifh  an  opinion 
entirely  free  from  objections.  It  however  appears  probable, 
that  excefiive  heat  operates  firft  by  indirectly  debilitating 
and  relaxing  the  furface  of  the  body,  and  then,  by  confent 
of  parts,  relaxing  the  inteftinal  tube.  We  well  know,  that 
the  {kin  and  alimentary  canal  mutually  participate  in  health 
and  difeafe.  Hence  we  may  eafily  conceive,  that,  as  the  long 
application  of  violent  heat  may  overftretch  and  relax  the 
veiTels  on  the  furface,  and  caufe  an  excefiive  difcharge  of  per- 
fpirable  matter  ;  the  internal  parts,  either  at  the  fame  time, 
or  during  the  interval  of  its  application  to  the  external  parts, 
may  fuffer  a  preternatural  exudation  there  of  the  various 
fecretoiy  difcharges.  Thefe  fluids  may  accumulate,  and 
from  ftagnation  and  the  continuance  of  heat,  become  pre- 
ternaturally  acrid,  fo  as  to  irritate  and  excoriate  the  very 
delicate  coats  of  the  interlines.*  Acidity  is  always  increafed 
in  the  prima  vis,  during  warm  weather.  And,  as  the  appli- 
cation of  ftimulants,  is  generally  more  powerful,  in  proportion 
as  the  body  is  weakened,  it  appears  evident,  that  the  -ufe  of 
all  indigeftible  food,  &c.  will  much  more  readily  induce 
difeafe.  But,  as  this  difeafe  prevails  efpecially  at  the  com- 
ing 

*  What  greatly  favours  this  opinion,  is,  that  children  who  poffefs  a 
much  larger  proportion  of  fluids,  -efpecially  of  the  mucous  kind,  than 
grown  people,  and  adults  of  a  fimilar  make,  are  particularly  liable  t* 
this  complaist, 


(     19     ) 

ing  on  of  cold  and  rainy  weather,  after  great  heats,  we  may' 
fuppofe,  that,  from  the   fudden    fuppreffion  .of  perlpirartion, 
and  the  relaxation    of  the   fyllem,  there  will   be  a   greater 
afflux  of  fluids  to  thefe  parts,  which  irritate  in  proportion  to 
the  debility. 


PROGNOSIS. 

THE  extreme  irritability  of  the  infant  fyfteni,  render- 
ing judgments  drawn  from  the  pulfe  precarious,  their  being 
eafily  reduced  by  ficknefs,  and  their  incapacity  to  exprefs 
their  diftrefs,  as  well  as  the  difficulty  of  adapting  our  re- 
medies to  every  particular  emergency  of  early  impotence, 
render  a  prognofis  often  extremely  difficult.  While  on  the 
other  hand,  children  are  not  under  the  influence  of  many 
tircumflances,  which  retard  the  recovery  of  adults.  They 
are  not  influenced  by  various  impreflions  on  the  mind,  their 
difeafes  are  far  lefs  complicated,  their  habits  lefs  vitiated, 
their  wants  but  few  and  fimple,  feldom  of  a  hurtful  kind, 
and  they  appear  to  be  more  immediately  under  the  guidance 
of  nature.  Hence  it  is  the  opinion  of  an  elegant  and  judi- 
cious writer,  that  H  we  ought  never  to  defpa'ir  of  a  child's 
life,  while  it  continues  to  breathe".* 

When  the  difcharge  is  moderate,  and  not  of  an  acrid 
natuie,  if  it  does  not  injure  the  child's  health,  and  particu- 
larly, if  fleep  is  little  diilwbcd,  and  the  functions  of  the 
ftomach  are  not  impaired,  we  may  view  the  diieafe  as  in 
fome  meafure,  of  a  barmlefi  nature. 

may  generally  predict  &  favourable  termination,  if  the 
difeafc  proceed  from  cold,  or  fomc  little  impropriety  in 
if,  after  the  exhibition  of  the  proper  remedies,  the  vomiting 

C  2  (when 

*  Gregory'*   Comp.  View. 


(       2Q       ) 
(when  it  attends)  is  fuppreffed,  the  purging  either  flops  en- 
tirely, or    in   part,  and  the  matter  voided,  affumes  a  more 
natural   appearance,    and   efpeciajly  if  at  the  fame  time,  an 
eruption  appears  on  the  fkin. 

If  the  child  be  dry-nurfed,  and  his  fleih  become  flabby, 
his  colour  pale,  and  the  flools  of  a  black  colour,  and  fetid, 
the  prognolis  will  be  more  doubtful. 

But,  when  the  difeafe  is  epidemic,  when  it  has  continued 
for  a  long  time,  attended  with  a  frequent  vomitino-  of  acid 
or  bilious  matter,  and  an  inability  to  retain  any  thing  on  the 
ftomach,  it  will  be  very  unfavourable.  And,  if  a  frequent 
hiccup,  livid  fpots,  that  peculiar  tightnefs  of  the  fkin 
(called  fkin-bound)  a  fore  mouth,  convuifions,  and  a  general 
emaciation  of  the  body  fupervene,  it  will  terminate  fatally. 


METHOD     of     CURE. 

Before  we  enter  on  the  method  of  cure,  it  will  be  proper 
to  remark,  that  it  is  not  every  kind  or  degree  of  Diarrhoea, 
that  is  to  be  viewed  as  a  difeafe.  A  iraall  degree  of  loofe- 
nefs  is  common,  and  may  often  prove  of  fervice  to  children. 
The  bowels  appear  to  be  the  great  natural  and  critical  outlet 
in  them,  as  the  kidneys  and  furface  of  the  body  are  in  adults.* 
It  is  chiefly,  when  the  difeafe  arifes  from  (oxns  powerful  caufe, 
or  fome  caufe  often  repeated,  when  the  difcharge  i»  excejjive  in 
degree?  or  of  an  unnatural  appearance,  and  particularly  when 
threatened  with  fymptoms^f  debility,  that  remedies  become 
immediately  necsfiary.  I  fay  immediately  neeeffary,  becaufe 
the  leaft  delay,  under  fuch  circumftances  may  often  put  it  out 
of  our  power  to  afford  any  effectual  relief. 

We 
*  Dr.  Underwood. 


Tot  ^ 

We  fhall  omit  taking  notice  of  any  fymptSmatic  Diarrhoea 
(arifing  from  dentition,  worms,  £sV.)  as  thefe  require  a 
method  of  treatment,  fuited  to  the  primary  complaint. 

This  difeafe  may  be  often  entirely  prevented  by  a  timely 
attention  to  obviating  the  remote  caufes,  both  predifponent 
and  occaiional.  We  may,  for  this  purpofe,  employ  every 
means  for  giving  jlrength  to  the  fyftem,  by  the  daily 
ufe  of  the  cold  bath,  by  the  moderate  life  of  animal  food,  of 
a  light  kind,  and  the  occafional  ufe  of  a  little  Port  Wine. 
The  utmoft  attention  to  cleanliaefs,  the  accommodation  of 
the  drefs  to  the  (bate  and  changes  of  the  weather,  and  the  re- 
moval of  children  to  the  country,  at  the  approach  of  the 
fummer  fcfon,  will  be  of  eflential  benefit.* 

Before  we  form  our  method  of  cure,  it  will  be  proper  to 
attend  to  the  remote  caufes,  and  to  endeavour  to  remove,  or 
moderate  them.  If  the  remote  caufe  be  cold  and  moiftare, 
it  will  be  neceftary  to  obviate  the  effects  of  thefe,  by  keeping 
the  patient  warm  and  dry  ;  or,  if  it  proceed  from  improper 
food,  to  change  it  for  that  which  is  more  wholefome. 

In  the  idiopathic  Diarrhoea,  the  indications  of  cure,  ai 
founded  on  the  view  of  obviating  and  removing  the  remote 
and  proximate  caufes,  and  as  fully  confirmed  by  experience, 
may  be  reduced  to  the  following  heads : 

i.  To  evacuate  the  acrid  fordes  from  the  ftornrxh  and 
intefl: 

2.  To  dimiiiifli  the  irregular  action  of  the  parts,  and 

3.  'j  the  ftrength  and  vigor  of  the  whole  fyftem. 
The  fir  ft.  intention  is  anfwereel  by  the  exhibition  • 

and  Emetics.  ll< :;v,   (hat 

e  few  cafes,  where  the  difeafe  is  far  advanced,  and 

of  great   debility,    and    01  may 

•  Rush,  on  the  "  C 


(     22     ) 

centraindicate  their  ufe,  we  may  pafs  over  this  indication, 
and  have  immediate  recourfe  to  the  remedies  hereafter  to  be 
mentioned.  Though  in  general,  it  is  of  the  utmolt  import- 
ance to  attend  carefully  to  emptying  the  ftomach  and 
bowels,  and  a  circumftance  that  ought  by  no  means,  except 
in  the  inflances  before  mentioned,  to  be  neglected. 

Perhaps  one  of  the  greateft.  errors  in  Medicine,  and  one 
v/hich  is  neverthelefs  too  often  apparent,  is  a  hafty  and 
blind  attachment  to  particular  remedies,  to  the  entire  ex- 
clufion  of  others  of  equal,  or  perhaps  fuperior  virtues.  It 
would,  no  doubt,  be  of  great  fervice  in  the  practice  of 
Phyfic,  to  keep  in  mind,  and  apply  to  moft  of  difeafes,  the 
practical  remark  of  the  learned  Boerhaave  ;  "  Nullum  fe  cog- 
novi/fe  remedium,  quinfolo  tempeJli<vo  ufu  talejieret"  Phyficians 
would  not  then  obftinately  adhere  to  one  uniform  mode  of 
treatment,  without  any  regard  to  the  variety  and  fucceflion 
of  Jymptoms.* 

This  has  been  a  fault,  particularly  in  treating  the  difeafes 
of  children.  Some,  from  an  idea,  that  acidity  is  the  fole 
and  primary  caufe  of  their  difeafes,  have  advifed  the  conflant 
ufe  of  abforbent  and  alkaline  medicines.  While  others,  pro- 
bably from  feeing  the  bad  effedts  of  the  injudicious  ufe  of 
thefe  remedies,  and  the  advantages,  in  many  cafes,  of 
emetics,  have  been  as  ftrenuous  in  their  oppofition  to  the  for- 
mer, and  defence  of  the  latter.  Whereas,  if  we  were  more 
guided  by  reafon,  and  the  appearance  of  fymptoms,  we  mould 
feldom  run  into  thefe  exceffes,  and  there  would  be  lefs  vari- 
ation of  opinion  and  practice  among  phyficians. 

*  "  Mutatis  mutandis,"  conduft  fhould  be  regulated  by  circum- 
ftances,  is  a  maxim  fully  as  proper  in  Medicine,  as  in  Morals  and 
Politics.  Both  Harris  and  Armfhong,  almoft  indifcriminately.  re- 
commend the  ufe  of  their  refpeclive  favourite  remedies,  and  declare, 
"  that  they  are  as  effectual  in  curing  the  Gripes,"  (as  it  is  frequently 
called)   "  as  the  bark  in  intermittents." 


(    *3    ) 

In  determining,  whether  purgatives  or  emetics  are  mo  ft 
proper  to  be  adminiftered,  in  this  complaint,  it  will  be  highly 
neceffary  to  attend  to  the  particular  fymptoms.  When  the 
bowels  alone  are  affe&ed,  fo  as  to  produce  limply  too  fre- 
quent a  difcharge  of  their  contents,  without  the  affection 
being  immediately  communicated  to  the  ftomach,  and  unac- 
companied with  fymptoms  of  fever,  purgatives  will  be 
fufficiently  fafe. 

If  a  want  of  the  ufnal  appetite,  a  loathing  of  food,  or 
when  aliments  are  taken  in,  an  uneafinefsin  the  time  of  their 
digeftion,  fuch  as  flatulence,  acid  eructations,  &c.  occur, 
emetics  will  be  neceffary.  Arid  it  will  be  particularly  necef- 
fary to  have  recourfe  to  emetics,  if  along  with  ficknefs,  naufea, 
and  vomiting,  the  febrile  fymptoms  run  pretty  high.  Alfo,  if 
the  complaint  has  been  of  confiderable  duration,  and  re- 
turned feveral  times,  after  having  remitted,  or  entirely  gone 
off.  Emetics  have  fome  confiderable  advantages  over  purga- 
tives in  Diarrhoea,  which  render  them  particularly  ufefnl. 
They  more  effectually  empty  the  ftomach,  and  perhaps  the 
fmaller  inteftines,  and  determine  freely  to  the  furface.  It  is 
probable  alfo,  that  vomiting  may  give  fome  inverfion  of  the 
periftaltic  motion  which  is  determimined  too  much  down- 
wards in  Diarrhoea.* 

The  remedies  proper  to  be  employed  as  cathartics,  are 
rhubarb,  magncfia,  or  thefe  combined,  and  in  fome  cafes, 
talomel  well  prepared.  This  Jail  is  faid  to  be  particularly 
ufefnl,  given  to  children  above  four  or  five  months  old,  in 
dofes  of  half  a  grain,  when  the  bowels  arc  foul,  and  the  ftooli 
•try   offcnfive.f      Manna  and   cajlor  oil,    which    have     been 

*   Y:n  Swieten  in  Boerhaav. — Tom.  2,  p.  389.— Cullca's  Fir  ft  Lin's. 
+   Dr.  Armllr"  . 


(      -4     ) 

employed,  on  this  occafion,  appear  to  me  equally  improper  ;  a» 
the  latter  is  very  apt  to  become  rancid,  during  warm  weather  ; 
and  the  former,  from  its  being  entirely  of  a  facchar'ine  nature, 
will  readily  increafe  the  fermentation,  and  confequent  acidity 
in  the  already  debilitated  itomach. 

The  emetics  ufuaUy  adminiitered  in  this  difeafe,  are  Ipecacu- 
anha and  the  anlimonial  medicines.  The  antimonial  wine, 
fince  the  high  character  given  of  it  by  Dr.  Armstrong,  has 
been  viewed  as  almoll  a  fpecific  in  the  difeafes  of  children 
in  general,  and  of  Diarrhoea  in  particular.  But,  as  it  is 
difficult  to  afcertain  the  exact  dofe  of  this  medicine,  from 
its  difference  of  ftrength,  which  is  greater  or  lefs,  according 
to  the  greater  or  lefs  degree  of  acidity  of  the  wine  in  its  pre- 
paration and  from  fome  other  confiderations;  the  Tartar  Eme- 
tic, as  being  lefs  liable  to  variation,  appears  to  me  a  preferable 
medicine.  This  lad  can  be  given  in  any  neceffary  quantity, 
with  a  very  great  degree  of  exactnefs. 

But,  as  fome  perfons  have  ilrong  prejudices  againft  the 
ufe  of  this  excellent  remedy  among  children,  in  order  to 
remove  thefe  prejudices  or  fcruples,  and  to  prevent  the  effects 
of  an  imprudent  administration  of  this,  and  other  emetics, 
the  following  circumftances  are  worthy  of  attention.  Eme- 
tics ought  never  if  pofnble,  to  be  given  to  infants,  on  art 
empty  Jlomach  ;  nor  while  the  bowels  are  coftive.  Hence  the 
mod  proper  time  for  their  exhibition,  is  generally  the  evening. 
We  ought  to  be  careful  not  to  give  with  the  antimonial 
emetics,  any  acid  or  acid  drink,  as  lemonade,  or  even  fugar, 
which  is  too  often  combined  with  thefe  medicines.  It  will 
alfo  contribute  to  render  the  operation  more  mild,  if  inftead 
of  the  common  mode  of  diffolving  the  emetic  fubftance,  in  a 
fmall  quantify  of  water,  we  add  a  large  bulk  of  fluid.  This 
will  render  the  medicine  more  tall  clefs  and  agreeable  (which 

with 


(     *5     ) 

with  children  is  an   objeft  deferving  confiderable  attention) 
and  prevent  the  emetic  from  convulfing  and  cramping  the  ilo- 
raactt.     We  (hall  alio    be   more   certain  of  a  perfect  Solution 
emetic  tartar. 
In  cafes,  aiding  from  acid  or  putrid  fordes  in  the  (lomacli, 
fever,  the  Ipecacuanha  is  Sufficiently  efficacious. 
the  complaint  is  occalioned  by  an  obstruction  of  pcr- 
fpiration,  and  is  attended  with  a  hot  and  dry    ilate    of  the 
a  .  i,   when  from  the    marks    of  acidity  and  debility  in 
h,  the  emetic  tartar  may  b'e  viewed  as   not  tuffiqi- 
I  would  recommend  the  life  of  the  ^qmes'spoivaer* 
But   :      thi     medicine  Sometimes  runs  off  too  quickly  by  the 
bowels,   it  will  he  of  Service  to  add  a  grain  or  two  of  ipecacu- 
anha to  evei  y  dofe  of  the  James's  powder.     Some  of  the  good 
effecls  of  antimonials  are  juflly  attributed  to   their   relaxing 
n,  and  producing    a  determination    from   the  internal 
Tor  thefe  purpofes,  the  above  powder  mull  be  highly 
tageous,  as  it  appears  from  observation,  to  poffefs   the 
quality  in   a  Superior  degree  to  all  the  other  anti- 
preparations** 
.  be  difficult,  from  the  weaknefs  and  irritability  of  the 
•h,  to  retain  the  emetic  for  a  Sufficient  time,  it  ought 
to  be  given  in  very  Small  dofes,  and  often  repeated.     Or,  wc 
lave  recourse  to  purgatives,    combined  with  opiates ; 
or  medicines  administered  per  anum. 

The  2d.   indication    is  to   be  fulfilled  by  the  ufe   of  abfor- 
opintes,  the  watm  bath,  particularly  fomentations  of 
the  abdomen  and  warm  emollient  lavements. 

re  hive  been  great  prejudices  entertained   by  fome 

phytic!  10  ufe  of  what  are  called  antacids,  or  ab- 

L)  /->  • 

»D  '  Phytic,    i7«)2— i- 


(     26     ) 

/orients,*  and  opiates.-f  And,  that  the  indifcrhnlnate  ufe  of 
thefe  remedies  has  done  great  harm,  we  cannot  but  lament. 
But,  furely,  after  the  ftomach  and  bowels  have  been  two 
or  three  times  freely  emptied  of  their  acrid  contents  (as  be- 
fore directed)  there  can  be  no  impropriety  in  removing  all 
remaining  acid  tendency,  by  the  ufe  of  abforbents,  ufually 
given  for  that  purpofe,  and  in  allaying  irrhafwn,  by  the  fame 
remedies  and  opiates.  With  refpe6t,  however,  to  thefe  reme- 
dies, it  will  be  proper  to  remark,  that  to  derive  benefit 
from  them,  the  fir  ft  ought  to  be  adminiftered  in  large 
dofes,  though  not  often  repeated ;  and  the  latter  is  feldom 
to  be  given,  while  the  {tools  are  green,  or  have  a  very  unna- 
tural appearance.  Magnejia  is,  in  general,  preferable  to  all 
other  abforbent  medicines.  But,  when  given  rneielyasan 
abiorbent  of  acidity,  it  ought  to  be  in  its  pure  and  calcined 
ftate.  When  given  in  its  impure  ftate,  it  is  apt  to  occafion 
pain  and  flatulencies,  from  the  difengagement  of  the  carbonu 
acid.  Given  in  the  manner  here  directed,  it  is  perfectly 
mild  (free  from  cauMicity)  and  as  it  contains  more  of  the 
real  earth  of  magnefla,  it  rauft  be  more  effectual.;}; 

To  remove  pain  and  irritation  in  the  ftomach  and  inteftin£3, 
it  will  be  of  great  fervice  to  apply  flannels,  wrung  out  of 
brandy  and  warm  water,  over  the  abdomen.  And,  where 
nothing  can  be  retained  on  the  ftomach,  to  apply  an  opiate 
platter,  or  a  plafter  made  of  fome  of  the  eflential  oils,  and 
warm  gums. 

Our  3d.  indication  is  to  be  anfwered  by  tonic  and  ftimulant 
medicines,  and  a  nourifliing  diet. 

The  principal  tonic,  or  ftrengthening  medicine  in  this,  as 
in  other  difeafes,  attended  with  debility,  is  the  Peruvian  bark. 
But,  as  children  are  very  averfe  to  fwallow  medicines,  which 

*  Dr.  Armftrong. 

f  Van  Swieten  Tom.  4  P.  662,  &c.  Hairis. 

%  Black  on  Magnefta,     Ptidtley  on  Arr. 


k   27   ) 

*re  naufeous  to  the  tafte,  and  that  require  to  be  taken  in  large 
quantities  ;  for  thefe,  and  fome  other  reafons,  it  appears  to 
me,  that  the  bark  ought  feldonito  be  given  to  them  infuMaace.* 
Various  bitter,  and  flightly  altringent  fubftances,  may  alfo 
be  advantageoufly  given  in  the  advanced  flate  of  the  com- 
plaint, and  after  the  free  ufe  of  the  before  mentioned  remedies. 
Bitters,  befides  their  power  of  ttrengthening  the  ftomach, 
have  the  property  of  correcting  acidity  and  flatulence,  which 
they  do  out  of  the  body.f 

The  flimulants  employed  are  chiefly  dramatics  and  the 
'warm  feeds,  which  are  generally  employed  as  carminatives. 
Thefe  are  neceiTary  in  long  continued  Diarrhoeas,  where 
there  is  no  fever,  and  where  there  is  a  conhdtYixblz  Jfiafmodic 
ajfetTion  of  the  bowels.  It  is  fometimes  of  fervice  to  add  thefe 
ftimulants,  or  what  is  fuperior,  a  little  of  the  volatile  alkali 
well  diluted,  to  the  abforbent  medicines.  To  thefe,  or  a 
combination  of  them  with  opium,  it  will  often  be  neceflary 
to  have  immediate  recourfe ;  efpecially  when  the  patient  is 
much  weakened,  and  there  is  reafon  to  think,  that  the  of- 
fending matter  has  been  already  evacuated  by  the  efforts  of 
nature. 

D  2  But, 


"  The  method  of'  giving  (he  bark   in  fubftance,  it  in  many  cafes  im- 
proper, on  tliis   account;  that  the  Iigneouc    ,md    indigestible  part  of  it 
mu!t  neceffarily  irritate   and    injure    the    very    delicate  coats  of   the  flo- 
rid inieftines.      Hence  its  readinels  to  Lie  rejected  ;  and,  probably 
alfo,   ill  frequently  prodm  nit;  Diarrhoea,  and  pain    and  tincture  in  the 
■  litis  arife  from  the  woody  part  of  the  baik.    we 
infer  froin  '.he    inlufion    of  it   in  cold  water  and  magncfia,  being  frc- 
u'ned    on  the  ftomach,  alter    the    bark  in   fubftancc    •  s  it  is 
called)  had  been  conftantly  thrown  up.     The  addition  oi  the    lagnefia* 
eated   of,   is  obvioufly  advantageous       Dr.   Ro- 
•  1  M   M   l.- ftun    on  Few< 

Mat.  M 


(     28     ) 

f  But,  an  object  of  equal,  or  perhaps  fuperior  importance 
to  any  that  has  been  mentioned,  is  the  regulation  of  the 
did.  When  children  at  the  breaft,  are  attacked  with  this 
dileafe,  the  nurfe  ought  to  avoid  every  thing  that  may  injure 
her  milk  ;  if  fhe  has  lived  on  a  vegetable  diet,  flie  mud  change 
it  for  one  of  a  more  animal  nature.  It  will  be  neceiTary  to 
alternate  the  ufe  of  a  little  animal  broth  with  the  mother's 
milk  to  the  child,  or  to  change  the  nurfe.  And,  when 
children  are  brought  up  by  the  hand,  or  fomewhat  advanced 
in  age,  we  muft  employ  chiefly  the  nutritious  juices  of  anl- 
malSj  freed -from  all  oily,  indigeftible  matter,  fuch  as  ve Si  arid 
chicken-broth ,  beef-tea,  and  calves-feet  jelly.  Animal  food,  given 
in  tin's  manner,  will,  belides  being  eafy  of  digeuion,  and 
affording  a  rich  chyle,  contribute  greatly  to  correct  the 
acid  tendency  in  the  prima  vice.  If  the  child  be  unable  to 
take  milk  from  the  nurfe,  it  will  be  neceiTary  to  fubdi- 
tiite  fomething,  which  approaches  human  milk  as  nearly  as 
pofiible.* 

Some  of  the  farinaceous  fubftances,  fuch  asfalep,  fago, 
and  tapioca,  are  aifo  employed  with  advantage. 

But,  if  all  thefe  medicines  fhould  fail,  and  children  ate 
attacked  with  this  complaint,  during  the  warm  feafons  of 
the  year,  it  will  fometimes  be  found,  that  the  belt  remedy  in 
this,  as  in  the  moil  of  chronic  difeafes,  will  be  pure,  country 
air,  and  feme  gentle  exercife  of  geflation. 


It  would  be  ingratitude  in  me,  were  I  fo  conclude  this 
effay,  without  expreiTing,  in  the  warmeil  terms,  my  fenti- 
rnentG  of  refpeot  and  efteero,  to  thofe  medical  gentlemen, 
from  whom  I  have  received  repeated  marks  of  friend/hip  and 

*  As  A'ffes'  or  Goat'A-rr.ilJc,  when  thefe  can  be  procured  ;  or,  by 
adding  to  one  part  6'f  fre'ft;  Cow's  milk  two  parts  of  pure,  well  boiled 
water,  while  vvarvu. — VanSwieten  in  BoeiLauv. — Mofs  on  Nurfing. 


C    29   ) 

kindnefs.  To  Doctors  Wm.  Moose,  11.  KhTam,  andWm. 
P.  Smith'  of  this  city  ;  as  well  as  to  Dr.  Vavick  of  New- 
Jerfey,  I  am  particularly  indebted.  Permit  me  to  affure 
thpfe  gentlemen,  that  as  long  as  ufeful  and  difiuterefted 
fervices  merit  regard,  and  while  gratitude  deferves  to  be 
viewed  as  a  viitue,  a  grateful  remembrauce  of  their  names 
mall  not  be  effaced  from  my  mind. 


FINIS. 


